Effect of Auditory Evoked Potential Index Monitoring on Anesthetic Drug Requirements and Recovery Profile after Laparoscopic Surgery

2003 ◽  
Vol 99 (4) ◽  
pp. 813-818 ◽  
Author(s):  
Alejandro Recart ◽  
Paul F. White ◽  
Agnes Wang ◽  
Irina Gasanova ◽  
Stephanie Byerly ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Fast Track ◽  
Evoked Potential ◽  
Rating Scale ◽  
Auditory Evoked Potential ◽  
Control Group ◽  
Early Recovery ◽  
Anesthetic Drugs ◽  
Desflurane Concentration ◽  
Pacu Stay

Background The auditory evoked potential (AEP) monitor provides an electroencephalogram-derived index (AAI) that has been reported to correlate with the central nervous system depressant effects of anesthetic drugs. This clinical utility study was designed to test the hypothesis that AAI-guided administration of the maintenance anesthetics and analgesics would improve their titration and thereby provide a faster recovery from general anesthesia. Methods Seventy consenting patients undergoing elective general surgery procedures were randomly assigned to either a control (standard clinical practice) or AEP-monitored group. Although the AEP monitor was connected to all patients, the information from the monitor was only made available to the anesthesiologists assigned to patients in the AEP-monitored group. In the AEP-monitored group, the inspired desflurane concentration was titrated to maintain an AAI value of 15-20. In the control group, the inspired desflurane concentration was varied based on standard clinical signs. The AAI values and hemodynamic variables, as well as end-tidal desflurane concentrations, were recorded at 3- to 5-min intervals. The recovery times to achieve a White fast-track score greater than 12 and an Aldrete score of 10, as well as the actual duration of the PACU stay, were evaluated at 5- to 10-min intervals. Patient satisfaction with recovery from anesthesia was assessed using a 100-point verbal rating scale at 24 h after surgery. Results The average intraoperative AAI value in the AEP-monitored group was significantly higher than in the control group (16 +/- 5 vs. 11 +/- 8, P < 0.05). Use of the AEP monitor reduced the desflurane requirement by 26% compared to the control group (P < 0.01). In addition, the AEP-monitored group received less intraoperative fentanyl (270 +/- 120 vs. 390 +/- 203 microg, P < 0.05) and more rapidly achieved fast-track eligibility (29 +/- 19 vs. 56 +/- 41 min, P < 0.05). The time required to achieve an Aldrete score of 10 (60 +/- 31 vs. 98 +/- 55 min) and the duration of stay in the recovery room (78 +/- 32 vs. 106 +/- 54 min) were also significantly reduced in the AEP-monitored (vs. control) group (P < 0.05). Conclusion Use of AEP monitoring as an adjunct to standard clinical monitors improved titration of anesthetic drugs, thereby facilitating the early recovery process after laparoscopic surgery.

Does the Use of Electroencephalographic Bispectral Index or Auditory Evoked Potential Index Monitoring Facilitate Recovery after Desflurane Anesthesia in the Ambulatory Setting?

2004 ◽  
Vol 100 (4) ◽  
pp. 811-817 ◽  
Author(s):  
Paul F. White ◽  
Hong Ma ◽  
Jun Tang ◽  
Ronald H. Wender ◽  
Alexander Sloninsky ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Evoked Potential ◽  
Auditory Evoked Potential ◽  
Ambulatory Setting ◽  
Control Group ◽  
Maintenance Period ◽  
Quality Of Recovery ◽  
Desflurane Concentration ◽  
End Tidal

Background Analogous to the Bispectral Index (BIS) monitor, the auditory evoked potential monitor provides an electroencephalographic-derived index (AAI), which is alleged to correlate with the central nervous system depressant effects of anesthetic drugs. This clinical study was designed to test the hypothesis that intraoperative cerebral monitoring guided by either the BIS or the AAI value would facilitate recovery from general anesthesia compared with standard clinical monitoring practices alone in the ambulatory setting. Methods Sixty consenting outpatients undergoing gynecologic laparoscopic surgery were randomly assigned to one of three study groups: (1) control (standard practice), (2) BIS guided, or (3) AAI guided. Anesthesia was induced with 1.5-2.5 mg/kg propofol and 1-1.5 microg/kg fentanyl given intravenously. Desflurane, 3%, in combination with 60% nitrous oxide in oxygen was administered for maintenance of general anesthesia. In the control group, the inspired desflurane concentration was varied based on standard clinical signs. In the BIS- and AAI-guided groups, the inspired desflurane concentrations were titrated to maintain BIS and AAI values in targeted ranges of 50-60 and 15-25, respectively. BIS and AAI values, hemodynamic variables, and the end-tidal desflurane concentration were recorded at 5-min intervals during the maintenance period. The emergence times and recovery times to achieve specific clinical endpoints were recorded at 1- to 10-min intervals. The White fast-track and modified Aldrete recovery scores were assessed on arrival in the PACU, and the quality of recovery score was evaluated at the time of discharge home. Results A positive correlation was found between the AAI and BIS values during the maintenance period. The average BIS and AAI values (mean +/- SD) during the maintenance period were significantly lower in the control group (BIS, 41 +/- 10; AAI, 11 +/- 6) compared with the BIS-guided (BIS, 57 +/- 14; AAI, +/- 11) and AAI-guided (BIS, 55 +/- 12; AAI, 20 +/- 10) groups. The end-tidal desflurane concentration was significantly reduced in the BIS-guided (2.7 +/- 0.9%) and AAI-guided (2.6 +/- 0.9%) groups compared with the control group (3.6 +/- 1.5%). The awakening (eye-opening) and discharge times were significantly shorter in the BIS-guided (7 +/- 3 and 132 +/- 39 min, respectively) and AAI-guided (6 +/- 2 and 128 +/- 39 min, respectively) groups compared with the control group (9 +/- 4 and 195 +/- 57 min, respectively). More importantly, the median [range] quality of recovery scores was significantly higher in the BIS-guided (18 [17-18]) and AAI-guided (18 [17-18]) groups when compared with the control group (16 [10-18]). Conclusion Compared with standard anesthesia monitoring practice, adjunctive use of auditory evoked potential and BIS monitoring can improve titration of desflurane during general anesthesia, leading to an improved recovery profile after ambulatory surgery.

scholarly journals The effect of TEAS on the quality of early recovery in patients undergoing gynecological laparoscopic surgery: a prospective, randomized, placebo-controlled trial

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiangdi Yu ◽  
Fangxiang Zhang ◽  
Bingning Chen
Keyword(s):  
Laparoscopic Surgery ◽  
Controlled Trial ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Control Group ◽  
Early Recovery ◽  
Quality Of Recovery ◽  
Vas Scores ◽  
T1 And T2

Abstract Introduction In current study we assessed the effect of transcutaneous electrical acupoint stimulation (TEAS) on the quality of early recovery in patients undergoing gynecological laparoscopic surgery. Methods Sixty patients undergoing gynecological laparoscopic surgery were randomly assigned to TEAS (TEAS group) or control group (Con group). TEAS consisted of 30 min of stimulation (12–15 mA, 2/100 Hz) at the acupoints of Baihui (GV20), Yingtang (EX-HN-3), Zusanli (ST36) and Neiguan (PC6) before anesthesia. The patients in the Con group had the electrodes applied, but received no stimulation. Quality of recovery was assessed using a 40-item questionnaire as a measure of quality of recovery (QoR-40; maximum score 200) scoring system performed on preoperative day 1 (T0), postoperative day 1 (T1) and postoperative day 2 (T2); 100-mm visual analogue scale (VAS) scores at rest, mini-mental state examination (MMSE) scores, the incidence of nausea and vomiting, postoperative pain medications, and antiemetics were also recorded. Results: QoR-40 and MMSE scores of T0 showed no difference between two groups (QoR-40: 197.50 ± 2.57 vs. 195.83 ± 5.17), (MMSE: 26.83 ± 2.74 vs. 27.53 ± 2.88). Compared with the Con group, QoR-40 and MMSE scores of T1 and T2 were higher in the TEAS group (P < 0.05) (QoR-40: T1, 166.07 ± 8.44 vs. 175.33 ± 9.66; T2, 187.73 ± 5.47 vs. 191.40 ± 5.74), (MMSE: T1, 24.60 ± 2.35 vs. 26.10 ± 2.78; T2, 26.53 ± 2.94 vs. 27.83 ± 2.73). VAS scores of T1 and T2 were lower (P < 0.05) in the TEAS group (T1, 4.73 ± 1.53 vs. 3.70 ± 1.41; T2, 2.30 ± 0.95 vs. 1.83 ± 0.88); the incidence of postoperative nausea and vomiting (PONV), remedial antiemetics and remedial analgesia was lower in the TEAS group (P < 0.05) (PONV: 56.7% vs. 23.3%; incidence of remedial antiemetics: 53.3% vs. 23.3%; incidence of remedial analgesia: 80% vs. 43.3%). Conclusion The use of TEAS significantly promoted the quality of early recovery, improved MMSE scores and reduced the incidence of pain, nausea and vomiting in patients undergoing gynecological laparoscopic surgery. Trial registration ClinicalTrials.gov, NCT02619578. Registered on 2 December 2015. Trial registry name: https://clinicaltrials.gov

scholarly journals Use of Air Arthrograms to Aid in Joint Distraction During Hip Arthroscopic Surgery Decreases Postoperative Pain and Opioid Requirements

2019 ◽  
Vol 7 (4) ◽  
pp. 232596711983738 ◽  
Author(s):  
Jonathan D. Hodax ◽  
Sergio E. Flores ◽  
Edward C. Cheung ◽  
Alan L. Zhang
Keyword(s):  
Postoperative Pain ◽  
Rating Scale ◽  
Cohort Analysis ◽  
Arthroscopic Surgery ◽  
Positive Pressure ◽  
Postanesthesia Care Unit ◽  
Control Group ◽  
Joint Distraction ◽  
Patient Reported ◽  
Pacu Stay

Background: Positive-pressure air arthrography and venting of the hip capsule are techniques used to decrease the traction forces needed for joint distraction during hip arthroscopic surgery. Little is known about the effects that these techniques have on postoperative pain. Hypothesis: Positive-pressure air arthrography and venting during hip arthroscopic surgery will decrease patient-reported pain and narcotic requirements in the acute postoperative setting. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort analysis was conducted to analyze 35 patients who underwent positive-pressure air arthrography and venting to aid joint distraction during hip arthroscopic surgery versus a group with similar demographics, pathologies, and treatments who did not undergo air arthrography. Numeric pain rating scale (NPRS) scores and medication administration including narcotic and nonnarcotic analgesia in the postanesthesia care unit (PACU) were tracked and compared. Results: The maximum (7.17 vs 4.97, respectively), minimum (2.43 vs 1.09, respectively), and mean (5.15 vs 3.11, respectively) NPRS scores were all higher in the control group compared with the air arthrogram group ( P < .001, P = .007, and P < .001, respectively). The administration of oral morphine equivalents (OMEs) during the PACU stay was significantly lower in the air arthrogram group, with a mean of 36.75 ± 11.37 OMEs, compared with 44.53 ± 16.06 OMEs in the control group ( P = .023). There was no difference in postoperative nonopioid medications, such as ketorolac or acetaminophen, given between groups. Conclusion: Patients undergoing hip arthroscopic surgery with air arthrography and venting used to aid distraction had significantly less postoperative pain and required a lower total dosage of opioids during their PACU stay when compared with patients who underwent hip arthroscopic surgery without air arthrography.

scholarly journals «FAST-TRACK» SURGERY OF ACUTE DESTRUCTIVE CHOLECYSTITIS

2020 ◽  
pp. 27-30
Author(s):  
A. N. Veligotsky ◽  
A. S. Chebotaryov ◽  
V. S. Strakhovetsky ◽  
S. G. Fedorovskyi ◽  
A. S. Fomina
Keyword(s):  
Experimental Study ◽  
Laparoscopic Cholecystectomy ◽  
Laparoscopic Surgery ◽  
Postoperative Complications ◽  
Fast Track ◽  
Control Group ◽  
Study Group ◽  
Fast Track Surgery ◽  
Results Of Treatment ◽  
The Right

Summary. Aim. Introduction of «FAST-TRACK» principles in laparoscopic surgery of acute destructive cholecystitis. Materials and methods. The paper presents the results of an experimental study of the treatment of 210 patients with acute destructive cholecystitis, 104 patients in the control group and 106 comparative patients who were hospitalized and operated on in the clinic for the period from 2012 to 2019. Results and their discussion. In the control group, conversion and cholecystectomy were performed by lateral mini-access in the right hypochondrium. In the study group of patients performed laparoscopic cholecystectomy in similar conditions, but using original methods. Conclusions. As a result of the study it was possible to improve the results of treatment by 3.2 % and reduce the patient’s stay in the hospital from 6.5 days to 5.4 and reduce the number of postoperative complications by 80 % from 5 to 1 complication.

scholarly journals Transcutaneous Electrical Acupoint Stimulation Improves the Postoperative Quality of Recovery and Analgesia after Gynecological Laparoscopic Surgery: A Randomized Controlled Trial

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Yusheng Yao ◽  
Qiuyan Zhao ◽  
Cansheng Gong ◽  
Yihuan Wu ◽  
Ying Chen ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Postoperative Pain ◽  
Postoperative Analgesia ◽  
Control Group ◽  
Patient’S Satisfaction ◽  
Quality Of Recovery ◽  
Pain Scores ◽  
Pacu Stay ◽  
Acupoint Stimulation

Background. We conducted this prospective, randomized, double-blind, placebo-controlled study to evaluate the effects of transcutaneous electric acupoint stimulation (TEAS) on the quality of recovery (QoR) and postoperative analgesia after gynecological laparoscopic surgery.Methods. 74 American Society of Anesthesiologists physical status (ASA) I or II patients undergoing gynecological laparoscopic surgery were randomly allocated to TEAS or control groups. The primary outcome was the quality of recovery, which was assessed on the day before surgery and 24 h after surgery using a 40-item questionnaire. Secondary outcomes included postoperative pain scores, the incidence of postoperative nausea and vomiting (PONV), duration of postanesthesia care unit (PACU) stay, and patient’s satisfaction.Results. The TEAS group had higher QoR scores than control group upon 24 h after surgery (177 versus 165;P<0.001). Compared with the control group, postoperative pain scores and the cumulative number of opioids administered were lower in the TEAS group patients (P=0.04). TEAS reduced the incidence of PONV and dizziness, as well as duration of PACU stay. Simultaneously, the patient’s satisfaction scores were higher in the TEAS group (P=0.002).Conclusion. Preoperative TEAS enhances QoR, improves postoperative analgesia and patient’s satisfaction, alleviates postoperative side effects, and accelerates discharge after general anesthesia for gynecological laparoscopic surgery.

scholarly journals EFFECTS OF MALNUTRITION AND SENSORY-MOTOR STIMULATION ON AUDITORY EVOKED POTENTIALS

2016 ◽  
Vol 10 (2) ◽  
Author(s):  
Juraci Gonçalves De Lima ◽  
Carolina Araújo Rodrigues Funayama ◽  
Luiz Marcellino De Oliveira ◽  
Maria Rossato ◽  
José Fernando Colafêmina
Keyword(s):  
Auditory Evoked Potentials ◽  
Evoked Potential ◽  
Care Center ◽  
Small Sample ◽  
Auditory Evoked Potential ◽  
University Hospital ◽  
Laboratory Animals ◽  
Severe Malnutrition ◽  
Control Group ◽  
Nutritional Rehabilitation

There is evidence that the auditory evoked potential (AEP) is altered by malnutrition both in laboratory animals and in humans. The objective of the present study was to determine whether changes in the AEP caused by malnutrition could be reversed by nutritional rehabilitation and sensorymotor and environmental stimulation during hospitalization. Six children aged 5-33 months with severe malnutrition (kwashiorkor, marasmus and marasmic-kwashiorkor) were admitted to the Pediatric Ward of a University Hospital. Normal age and sex-matched children from the hospital day-care center were enrolled as a control group. The AEP was tested in an electrically and acoustically isolated room using a Nicolet CA 2000 microcomputer. Clicks of 90; 80; 70 and 60 dBn HL were presented through earphones. The results suggest that malnutrition leads to an increase in wave I latencies in patients with marasmus, and in waves I, III and V in those with kwashiorkor or marasmic-kwashiorkor type at 90 dB HL. At discharge, all but one patient with kwashiorkor showed reduced latencies of waves I, III and V compared to the values on admission. Despite the small sample, these preliminary results pointed out that the process of sensory stimulation used in our study in a properly directed, systematic and individualized manner showed encouraging results in terms of AEP recovery in these children. Keywords: malnutrition, infants, nutritional rehabilitation, auditory evoked potential, stimulation. 

scholarly journals The Difference of Brainstem Auditory Evoked Potential Latency in Diabetic Patient with Good and Poor Glycemic Control

2020 ◽  
Vol 8 (B) ◽  
pp. 457-462
Author(s):  
D. P. G. Purwa Samatra ◽  
Grace Meliana ◽  
I. G. N. Purna Putra ◽  
I Putu Eka Widyadharma
Keyword(s):  
Nervous System ◽  
Glycemic Control ◽  
Diabetic Patient ◽  
Evoked Potential ◽  
Smoking Habit ◽  
Auditory Evoked Potential ◽  
Poor Glycemic Control ◽  
Control Group ◽  
Cross Sectional ◽  
Brainstem Auditory Evoked Potential

BACKGROUND: Diabetes mellitus (DM) is a metabolic disorder which may complicate other organs, including the nervous system. Literatures which discuss about DM complications in the peripheral nervous system are easy to find but not so many of the central nervous system. Central diabetic neuropathy is a new concept which could be detected by a simple and non-invasive method, called brainstem auditory evoked potential (BAEP). AIM: The aim of the study was to find differences in BAEP latencies of a diabetic patient with good and poor glycemic control. METHODS: This was a cross-sectional study of 80 patients who came for follow-up in diabetic center and neurology polyclinic at Sanglah Hospital, from April to July 2016. The subjects were divided into two groups, depending on their glycemic control, then having BAEP examination. RESULTS: The unpaired t-test found prolonged BAEP latencies (either peak latency of wave III, V, IPL I-III, III-V, and I-V) in both ears at the poor glycemic control group, but the results were not differed significantly (p > 0.05). CONCLUSION: BAEP wave latencies were found prolonged in DM patient with poor glycemic control but not statistically significant. Further evaluation of BAEP latencies in DM patients is needed with prolonged duration and their relation with other comorbid factors, especially smoking habit.

scholarly journals Change in auditory evoked potential index and bispectral index during induction of anesthesia with anesthetic drugs

2014 ◽  
Vol 29 (5) ◽  
pp. 621-626 ◽  
Author(s):  
Sachiko Matsushita ◽  
Shinya Oda ◽  
Kei Otaki ◽  
Masaki Nakane ◽  
Kaneyuki Kawamae
Keyword(s):  
Bispectral Index ◽  
Evoked Potential ◽  
Auditory Evoked Potential ◽  
Anesthetic Drugs ◽  
Potential Index
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